Medical insurance generally referred to as "medical insurance", is a social insurance system established to compensate workers for economic losses caused by disease risks. Medical insurance has the basic characteristics of compulsory, mutual aid, and sociality of social insurance. The medical insurance system is usually implemented by national legislation and enforced, and a fund system is established. The expenses are jointly paid by employers and individuals. Commercial medical insurance.
Basic medical insurance is a social insurance system established to compensate laborers for economic losses caused by disease risks. It is an integral part of "social insurance" like basic endowment insurance, work-related injury insurance, unemployment insurance, and maternity insurance.
Basic medical insurance includes (urban) employee medical insurance, urban resident medical insurance, and new rural cooperative medical insurance. Employers and employees jointly pay basic medical insurance premiums by state regulations and establish medical insurance funds. After the insured suffers medical expenses due to illness or accident, the medical insurance agency will give certain economic compensation to avoid or reduce labor. economic risks caused by illness, treatment, etc. The new rural cooperative medical care and basic medical insurance for urban residents are combined with individual contributions and government subsidies, and the treatment standards are implemented by state regulations.
Commercial medical insurance is an integral part of the medical security system, which refers to the for-profit medical insurance operated by insurance companies. Units and individuals participate voluntarily, and the state generally encourages employers and individuals to participate in commercial medical insurance. In commercial medical insurance, consumers pay insurance premiums according to a certain amount. When encountering various diseases, they can obtain a certain amount of medical expenses from the insurance company.
Although basic medical insurance is the most widely covered type of insurance in my country's social insurance system, due to the particularity of urban individual economic organization owners and their employees, and considering the management ability of basic medical insurance and the risk of cost overruns, it is not possible to carry out basic medical insurance. all covered. Commercial medical insurance is a supplement to basic medical insurance. As long as any citizen or legal person with full capacity, as long as he voluntarily signs an insurance contract with an insurance company and pays insurance premiums under the contract, he can get certain protection.
With the deepening of the reform of the medical system, the types of commercial medical insurance also adapt to the situation and gradually increase. The insured can choose different types of commercial medical insurance according to their own needs and financial affordability, such as accidental injury medical insurance, major disease medical insurance, hospital medical insurance, special disease medical insurance, etc. Quality, affordable medical services.
(1) The two properties are different. Commercial medical insurance is a kind of insurance operated by life insurance companies using economic compensation. It is an aspect of social and economic activities, and life insurance companies can make profits from it. Basic medical insurance is a social security system established by the state by the Constitution to protect and improve the health of employees. It is enforced by the state or local governments through legislation and does not depend on personal will. Not-for-profit nature.
(2) Insurance objects and functions are different. Commercial medical insurance takes natural persons as the insured object, and its function is that when the insured citizen pays medical expenses due to accidental injury or disease, he can obtain certain economic compensation to reduce the loss, not to protect the basic life of the insured, nor to protect the insured. It has the function of maintaining social justice. Basic medical insurance mainly targets laborers. When laborers pay medical expenses due to illness, the social insurance department or its entrusting unit will provide basic compensation, which is conducive to social stability and maintenance of social fairness. It is national income. An aspect of redistribution.
(3) The rights and obligations of the two are different. Commercial medical insurance is based on a contractual relationship. The amount of insurance depends on the number of insurance premiums paid. More insurance is more, less insurance is less, and no insurance is not. The insurance company and the insured are equivalent exchanges. peer relationship. The rights and obligations of basic medical insurance are based on labor relations. As long as workers fulfill their obligations to work for society, they can enjoy social medical insurance benefits. The insurance benefits received by workers and the number of insurance premiums paid are the same as those of workers. Disproportionate relationship, that is, the relationship between rights and obligations is not equal.
The "14th Five-Year Plan" proposes that the protection of people's health should be placed in an important position, and the consolidation and expansion of poverty alleviation achievements should be effectively linked with rural revitalization. At present, China's urban and rural basic medical insurance has achieved nationwide coverage. The urban and rural basic medical insurance provides basic medical assistance to residents through individual payments and government subsidies. Basic medical needs.
However, due to the limitations of management ability, funding, and other conditions, basic medical insurance cannot provide comprehensive coverage, and the premiums of commercial medical insurance are far higher than the national basic economic level, and some low-income people cannot afford it. risks of.
Inclusive supplementary medical insurance is launched under this circumstance. It appears as a supplement to basic medical insurance. It is a benefits insurance product launched by local government joint insurance companies. It pays basic medical insurance for cities. It is launched by the insured, aiming to reduce the burden of the general public due to high medical expenses when major diseases occur, supplement the medical insurance coverage of the public, and help to establish a multi-level security system to alleviate the "disease-related medical expenses". The social phenomenon of causing poverty and returning to poverty due to illness has great value for people's livelihood.
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As the first inclusive supplementary medical insurance launched in Fujian, "Bamin Insurance" has the characteristics of low premium, low threshold, wide-coverage, and simple operation of insurance coverage. It is multi-level medical insurance in Fujian. Supplement to the system.
"Bamin Insurance" does not limit the occupation, age, and other conditions of the insured, and does not require the insurance to provide a certificate of health status. As long as the basic medical insurance is insured in Fujian except for Xiamen, all can be insured. One-year insurance of 69 yuan can enjoy 2.5 million yuan of insurance coverage, reasonable medical expenses within the scope of medical insurance due to diseases or accidents, proportional compensation for 25 special drugs in the catalog, and 12 health services such as health consultation.
Mr. Zeng from Fuzhou is 64 years old this year. In July 2020, as a participant of Fuzhou New Rural Cooperative Insurance, after a detailed understanding, he participated in the "Bamin Insurance" online through the official account. In October of the same year, Mr. Zeng was diagnosed with stomach cancer by Fuzhou's top three public hospitals. The total cost of the first phase of hospitalization, surgery, and special drugs was 62,097.74 yuan, of which 12,581.75 yuan was reimbursed by medical insurance, and 19,115.33 yuan was reimbursed by "Eight Min Insurance". In this case, the "Bamin Insurance" reduced Mr. Zeng's payment ratio by 39%, which greatly reduced personal medical expenses. During the term of the follow-up policy, Mr. Zeng paid 80% of the special medicines in the list directly, which greatly reduced the economic pressure of follow-up treatment.
